Risk factors for invasive mold diseases in allogeneic hematopoietic cell transplant recipients

Atalla, Ângelo; Garnica, Márcia; Maiolino, Ângelo; Nucci, Márcio

doi:10.1111/tid.12328

Cited by 36 publications

(23 citation statements)

References 41 publications

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“…The factors intervened after transplant; for example, the occurrence of early IA was associated with the absence of engraftment, late IA was associated with grades III to IV acute GVHD, and very late IA was associated with at least grade II acute GVHD, post-transplant relapse, and secondary neutropenia. Contrary to previous studies [1,9,10], we found that pretransplant factors, such as sex, donor type, stem cell source, and underlying disease, were not associated with the occurrence of IA. Because age was 1 of the matching criteria for choosing the control subjects, it was not studied as a risk factor.…”

Section: Discussioncontrasting

confidence: 99%

Mainly Post-Transplant Factors Are Associated with Invasive Aspergillosis after Allogeneic Stem Cell Transplantation: A Study from the Surveillance des Aspergilloses Invasives en France and Société Francophone de Greffe de Moelle et de Thérapie Cellulaire

Robin

Cordonnier

Sitbon

et al. 2019

Biology of Blood and Marrow Transplantation

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Invasive aspergillosis (IA) occurs in up to 23% of allogeneic hematopoietic stem cell transplantation (HSCT) patients. Although transplant procedures have changed over time, more late cases of IA are being observed. The objective of this study was to identify the pre-and post-transplant factors of IA in a large cohort of HSCT patients mainly transplanted with reduced-intensity conditioning. This multicenter, case-control study was carried out using data collected between 2005 and 2010 by the Surveillance des Aspergilloses Invasives en France program (Institut Pasteur, Paris) and the European Society for Blood and Marrow Transplantation ProMISe registry. Four control subjects without IA were individually matched to each case based on the center, patient age, and year of the transplant. We identified 185 cases of probable and proven IA and 651 control subjects. The median date of IA after the transplant was 133 days, with 35 cases (19%) of early IA (before day 40), 33 cases (18%) of late IA (days 40 to 100), and 117 cases (63%) cases of very late IA (after day 100). In the multivariate analysis early IA was significantly associated with a lack of engraftment, whereas late and very late IA were significantly associated with more than grade II acute graft-versus-host disease (GVHD); very late IA was also significantly associated with relapse and secondary neutropenia. Two-thirds of IA cases occurred more than 100 days after HSCT with different risk factors from those occurring earlier. Prophylactic strategies should consider the specific risk factors for late and very late IA, especially GVHD, relapse after transplant, and secondary neutropenia.

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Section: Discussioncontrasting

confidence: 99%

Mainly Post-Transplant Factors Are Associated with Invasive Aspergillosis after Allogeneic Stem Cell Transplantation: A Study from the Surveillance des Aspergilloses Invasives en France and Société Francophone de Greffe de Moelle et de Thérapie Cellulaire

Robin

Cordonnier

Sitbon

et al. 2019

Biology of Blood and Marrow Transplantation

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“…Several variables have been associated with a higher risk of developing IFI. They include HSCT from alternative donors, active hematologic malignancy at the time of transplant, older age, and presence of graft-versus-host disease (GVHD), CMV infection, and iron overload [1][2][3][4]. Appropriate assessment of these variables is essential to identify patients who may require more aggressive prophylaxis and/or antifungal therapies.…”

Section: Introductionmentioning

confidence: 99%

Hematopoietic cell transplantation comorbidity index and risk of developing invasive fungal infections after allografting

Busca

Passera

Madon

et al. 2018

Bone Marrow Transplant

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We evaluated the potential correlation of the hematopoietic cell transplantation comorbidity index (HCT-CI) with the risk of developing post-transplant invasive fungal infections (IFIs). Between January 2009 and March 2015, 312 consecutive patients who received a first allograft entered the study. Low/intermediate HCT-CI risk score (0-2) was observed in 172/312 (55%), whereas high HCT-CI score (≥3) was seen in 140/312 (45%). Overall, 51/312 (16%) patients experienced IFI, defined as possible in 19 (6%), probable in 27 (9%), and proven in 5 (2%). Cumulative incidence of probable-proven IFI at 1 year was 8.5% with a significant higher incidence in patients with high HCT-CI (12%) vs. those with low-intermediate HCT-CI (5%; p = 0.006). There was a strong trend for a higher incidence of baseline severe pulmonary comorbidity in patients who developed probable-proven IFI (p = 0.051). One-year cumulative incidence of non-relapse mortality was higher in patients with IFI vs. those without, 49 and 16% (p < 0.001). By multivariate analysis, disease status at transplant and high HCT-CI, when combined with acute GVHD, were independently associated with the risk of post-transplant IFI. This study shows that a high HCT-CI predicts the risk of developing IFI and may indicate the need of mold-active antifungal prophylaxis in high-risk patients.

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“…Invasive mould diseases (IMD) are increasingly frequent in the immunocompromised host, particularly in patients with acute leukaemia undergoing induction chemotherapy as well as in allogeneic hematopoietic stem cell transplant (HCT) patients . In this patient population, Aspergillus species account for a large number of fungal infections .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic work up to assess early response indicators in invasive pulmonary aspergillosis in adult patients with haematologic malignancies

Heinz

Vehreschild

Buchheidt

2019

Mycoses

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In immunocompromised patients with acute leukaemia as well as in allogeneic hematopoietic stem cell transplant patients, pulmonary lesions are commonly seen. Existing guidelines provide useful algorithms for diagnostic procedures and treatment options, but they do not give recommendations on how to evaluate early success or failure and if or when it is best to change therapy. Here, we review the diagnostic techniques currently used in association with clinical findings and propose an approach using a combination of computer tomography, clinical and all available biomarkers and inflammation parameters, especially those positive at baseline, to assess early response in invasive pulmonary aspergillosis. Computed tomography scans should be carried out at regular intervals during early and long-term follow-up. Imaging on day seven, or even earlier in clinically unstable patients, combined with an additional testing of biomarkers and inflammatory markers in between, is needed for a reliable assessment at day 14. If no improvement is seen after 2 weeks of therapy or the clinical condition is deteriorating, a change of antifungal therapy should be considered. Alleged breakthrough infections or treatment failure should undergo early diagnostic workup, including tissue biopsies when possible, to retrieve fungal cultures for resistance testing. K E Y W O R D S Aspergillus, biomarkers, diagnosis, imaging, treatment monitoring | 487 HEINZ Et al.

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Risk factors for invasive mold diseases in allogeneic hematopoietic cell transplant recipients

Abstract: The variables identified in this study may help to define risk groups, and to tailor special preventive measures to patients at higher risk to develop IMD.

Cited by 36 publications

References 41 publications

Mainly Post-Transplant Factors Are Associated with Invasive Aspergillosis after Allogeneic Stem Cell Transplantation: A Study from the Surveillance des Aspergilloses Invasives en France and Société Francophone de Greffe de Moelle et de Thérapie Cellulaire

Mainly Post-Transplant Factors Are Associated with Invasive Aspergillosis after Allogeneic Stem Cell Transplantation: A Study from the Surveillance des Aspergilloses Invasives en France and Société Francophone de Greffe de Moelle et de Thérapie Cellulaire

Hematopoietic cell transplantation comorbidity index and risk of developing invasive fungal infections after allografting

Diagnostic work up to assess early response indicators in invasive pulmonary aspergillosis in adult patients with haematologic malignancies

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